DADS CLASSPM, Section 4000, Consumer Directed Services (CDS)

Health and Human ServicesCommission/Texas Department of Aging and Disability ServicesCommunity Living Assistance and Support Services Provider ManualRevision: 13-2Effective: September 6, 2013

Section4000

Consumer Directed Services (CDS)

4100 Overview of CLASS Services Available Through the CDS Option

Revision 13-2; Effective September 6, 2013

In the Community Living Assistance and Support Services (CLASS) program, the Consumer Directed Services (CDS) option is available to individuals who choose to self-direct one or more of the following program services:

· CFC PAS/Hab

· CLASS Transportation - Habilitationhabilitation,

· In and out-of-home respite,

· nursing (includes registered nursing, licensed vocation nursing, specialized registered nursing and specialized licensed vocational nursing),

· Employment assistance

· Supported employment

· Cognitive rehabilitation therapy,

· physical therapy,

· occupational therapy, or

· speech/language pathology.

When individuals select the CDS option, they are required to use Financial Management Services (FMS). Individuals may also access support consultation if this is determined to be a necessary support to assist the individual in successfully using the CDS option.

FMS is provided by a Financial Management Services Agency (FMSA) chosen by the individual or legally authorized representative (LAR). FMS includes processing payroll and payables on behalf of the CDS employer. This includes serving as the CDS employer's fiscal/employer agent to ensure that federal, state and local employment taxes and labor and workers' compensation requirements are implemented in an accurate and timely manner. FMS also includes orientation, training, support and assistance with and approval of CDS employer budgets.

Support consultation is an optional service provided by a support advisor and provides a level of assistance and training beyond that provided by the FMSA through FMS. Support consultation helps a CDS employer to meet the required employer responsibilities of the CDS option and to successfully deliver program services. Individuals may choose a support advisor from the list of DADS(HHSC/DADS) certified support advisors on the CDS homepage of the DADSHHSC/DADS website at www.dads.state.tx.us/providers/cds/advisors.cfm. If desired, the FMSA must make a support advisor available to individuals to whom they provide FMS. Payment for support consultation is budgeted within the CDS portion of the individual's budget and is not a separate and distinct service on the Individual Plan of Care (IPC). Support consultation is available for CDS employers who choose additional support for hiring, dismissing, and training attendants. Support consultation provides more extensive training than CFC support management described below.

Community First Choice (CFC) support management offers training on how to select, manage, and dismiss an unlicensed service provider of CFC PAS/HAB. Support Management is a voluntary training benefit rather than a service. There will be no reimbursement rate for it. A Direct Services Agency (DSAs) and a Financial Management Services Agency (FMSA) are required to offer support management. ProviderDSAs and FMSAs will provide the CFC Support Management Handout (PDF) | Spanish (PDF), along with a verbal explanation, to individuals whose service plan includes Support Management.The State will provide resources to FMSAs to use as training material for the individuals who request support management.

4110 Offering the CDS Option

Revision 13-2; Effective September 6, 2013

The individual's CLASS case manager at the case management agency (CMA), is required to offer the CDS option at the time of CLASS program enrollment, at least annually, and at any other time upon request of the individual or LAR.

Individuals have a choice in how their services are delivered:

· Provider-ManagedAgency Option — The individual/LAR chooses to have a CLASS direct service agency (DSA) delivers all of their CLASS program services.

· CDS Option — The individual/LAR serves as the employer of direct service providers for those CLASS program services chosen to be delivered through CDS.

The service delivery option individuals select is based on their own preferences, as discussed during the service planning process. It is important to tell individuals they may switch service delivery options at any time. If they select the CDS option, they can switch to the provider-managed option at any time. However, if an individual switches from the CDS option to the provider-managed option, they must wait 90 days before switching back to CDS.

The CLASS case manager offers the CDS option by reviewing the following Department of Aging and Disability (DADSHHS/DADS) forms with the individual.

Form 1581, Consumer Directed Services Option Overview — The purpose of Form 1581 is to introduce the CDS option. Form 1581 gives an overview of the differences between the CDS option and the provider-managed option. This form, when signed, provides acknowledgement the CLASS case manager has provided, both orally and in writing, an overview of the benefits and responsibilities of the CDS option in CLASS.

· If the individual chooses at this point to decline the CDS Option, the case manager completes Form 1584, Consumer Participation Choice, indicating the choice of the Agency Option. The case manager does not complete DADSHHS/DADS Form 1582, Consumer Directed Services Responsibilities, Form 1583, Employee Qualification Requirements, or Form 1586, Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option.

· If the individual wants to know more about the CDS option, the case manager continues to Form 1582.

Form 1582, Consumer Directed Services Responsibilities — The purpose of Form 1582 is to provide more detailed information to the individual or LAR about the responsibilities assumed if the CDS option is selected. It concludes with the CDS Consumer Self-Assessment. If the individual or LAR (the employer) is not able to complete the Consumer Self -Assessment, a person appointed by the employer to be the employer's Designated Representative (DR) must be able to complete the Consumer Self-Assessment for the individual receiving services to participate in the CDS option. Form 1720 designates a representative for employer duties. The purpose of the self-assessment is to:

· assist the individual or LAR determine if they want to self-direct their services; and

· determine what support might be needed for the individual/LAR to self-direct services.

The self-assessment may not be used to determine that an individual/LAR cannot use the CDS option. If the individual or their LAR has difficulty responding to the self-assessment questions, they probably will need a designated representative (DR) to help them implement the CDS option. It is the FMSA's responsibility to assist them with appointing a DR.

· If the individual chooses at this point to decline the CDS option, the case manager completes Form 1584, indicating the choice of the Agency Option. The case manager does not complete DADSHHS/DADS Forms 1583 or 1586.

· If the individual wants to know more about the CDS option, the case manager continues to Form 1583.

Form 1583, Employee Qualification Requirements — The purpose of Form 1583 is to provide important definitions of terms used with CDS. This form includes information about who can be the CDS employer, who can be a DR, and who can and cannot be hired as an employee in the CDS option for CLASS.

· If the individual wants to select the CDS option, the case manager continues to Form 1584.

Form 1584, Consumer Participation Choice — The purpose of Form 1584 is to document the individual's/LAR's choice of service delivery option. If the individual or LAR is selecting the CDS option, the individual also must select an FMSA of his or her choice.

The case manager will provide a list of FMSAs serving the individual's CLASS catchment area. The FMSA choice list is on the DADS website at www.dads.state.tx.us/providers/cds/cdsas/CLASS.cfm.

To locate FMSAs serving the individual's local area, type in the county in which the individual resides. The case manager should encourage the individual or LAR to call and interview several FMSAs before selecting one.

Important: FMSAs are not required to be located in the same town in which the individual resides. FMSAs provide FMS. This service does not require ongoing face-to-face contact. While FMSAs are required to make one visit to the individual's home to conduct the CDS orientation before service initiation, the FMSA conducts the remainder of their business via email or fax with the individual or LAR, or DR if one has been appointed.

Form 1586, Acknowledgement of Information Regarding Support Consultation Services — The purpose of Form 1586 is to provide information to the individual or LAR regarding the availability of support consultation in the CLASS program. The use of support consultation is optional. If the individual or LAR requests support consultation during the service planning process, this service must be included in the IPC. During the development of the IPC, the number of units of support consultation must be determined for inclusion in the IPC. The amount and duration of support consultation needed by the individual will vary. Since payment for support consultation is drawn from the CDS employer's service budget, there are no additional funds available to pay for support consultation.

Support consultation includes practical skills training, coaching and assistance related to:

· Employer responsibilities

· principles of self-determination;

· recruiting, screening and hiring workers;

· completing documents and assessments required to employ a person, retain a contractor or vendor, and manage service providers;

· negotiating service agreements, including pricing and scheduling services, goods and items;

· effective communication, decision-making and problem-solving skills to meet employer responsibilities to effectively communicate with employees and service providers;

· tools for accessing information, resources and assistance;

· contacting appropriate people or entities based on their roles, responsibilities and eligibility related to the individual's program or the CDS option;

· participating in service planning team (SPT) meetings at the employer's request; and

· complying with requirements of the individual's program as related to services delivered through the CDS option.

A support advisor provides support consultation. FMSAs are required to make support advisors available in their agency if the service is authorized on the IPC. The list of DADS-certified support advisors is on the DADS website at www.dads.state.tx.us/providers/cds/advisors.cfm.

The individual or LAR may select a certified support advisor provided by his or her FMSA, or may opt to use choose a certified support advisor who is not associated with the FMSA from the list of certified support advisors.

The list of HHS/DADS-certified support advisors is on the HHS/DADS website at www.dads.state.tx.us/providers/cds/advisors.cfm.

Form 1720, Appointment of a Designated Representative --

The purpose of the form 1720 is to appoint a representative to do specific employer tasks delegated by the Individual or LAR. The individual or LAR will choose a designated representative if the individual is unable to perform certain employer tasks. The individual or LAR will fill out the specific tasks under the box "The DR is appointed to perform the following employer responsibilities", and if there are specific tasks the DR is not allowed to do, the individual or LAR will fill out box "The DR may not perform the following employer responsibilities". If the designated representative is not a relative, the Financial Management Services Agency (FMSA) needs to run a criminal conviction check using the Department of Public Safety public website.

Form 1735 - CLASS, Service Provision Requirements Addendum

The purpose of form 1735 is for the individual or LAR acting as the employer under the Consumer Directed Services option to review the services available in the CLASS program. The individual or LAR will also review requirements such as: who can and cannot be hired to provide services, employee qualifications, training requirements, service delivery documentation, service backup plans, and other special requirements that are program-specific. The individual is to review and initial on each section as acknowledgement that they understand and comply with CLASS program requirements.

4120 Service Backup Plans

Revision 13-2; Effective September 6, 2013

The CDS employer (individual or LAR) is responsible for developing a backup plan for CFC PAS/HAB or CLASS habilitation and nursing services. CLASS Transportation - Habilitation services do not require a service backup plan. CDS service backup plans are documented on Form 1740, Service Backup Plan. The CDS employer's plan must be reviewed and approved by the service planning team (SPT).

It is the case manager's responsibility during each IPP Service Review to review a CDS employer's backup plan to determine whether the strategies are reasonable and viable contingencies in the event an individual is unable to receive a critical program service by their regular service provider. If the case manager determines the strategies are not reasonable and viable, the case manager may support the CDS employer as needed to develop a viable plan. The case manager may also suggest the CDS employer consider using support consultation to assist in the development of a backup plan.

The CDS employer is responsible for providing the FMSA with the copy of each service backup plan within five working days after it has been approved by the SPT.

Backup plan strategies may include both formal and informal supports. If backup services are to be purchased from a CLASS DSA, the CDS employer must include such costs in the CDS budget. In addition, people who are paid to provide backup services must pass all criminal history and registry checks. Funds must be allocated in the individual's budget for criminal history checks of backup service providers.

4130 Service Planning

Revision 13-2; Effective September 6, 2013

The service planning teamSPT consists of the case manager, the applicant/individual/LAR, DSA representative(s), and other people requested by the applicant/individual/LAR to develop a proposed IPC, using Form 3621, CLASS/CFC – Individual Plan of Care. The FMSA does not play a role in the CLASS service planning process. FMSA staff does not attend SPT meetings, unless requested by the individual. The CDS employer is responsible for developing the habilitation plan in conjunction with the SPT. Any change in the amount of a service delivered through the CDS option must be discussed and justified by the SPT as part of the SPT process.

DADSHHS/DADS may, at any time, request documentation to justify a service. If DADSHHS/DADS requests this documentation for a service the individual or LAR has chosen to self-direct using the CDS option, the CDS employer is responsible for providing the documentation to DADSHHS/DADS. The CDS employer may request support from the case manager to provide this documentation for DADSHHS/DADS.